Digital Case Planning
Digital case planning combines examination findings with the appropriate images and intraoral records to assess treatment options. Which records are used, and whether a surgical guide is needed, is decided case by case.
What Is Digital Case Planning?
Digital case planning means assessing the examination findings together with appropriate images and intraoral records. The bone the implant will go into matters, but so do the position of the tooth on top, the bite and whether the result can be cleaned. The aim is to take the surgical and the prosthetic goal together.
A digital plan is not a guarantee of the outcome. It does not replace the examination, the clinician's decision, or the checks made during the procedure. Which records are used is chosen according to what the planned treatment needs.
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- Records are aligned — The necessary images and intraoral records are aligned in the same digital environment.
- The planned position — The implant position is planned together with the tooth it will carry and the neighbouring anatomy.
- A custom guide — The guide helps transfer the digital plan into the mouth; it does not replace the surgeon's judgement.
- Checks and a safety margin — How the guide seats is checked throughout; the final position can differ from the plan.
- Not every digital plan is carried out with a guide.
- A guide does not increase the amount of bone available.
- Guided surgery and flapless surgery are not the same thing.
Is an Intraoral Scan the Same as a CBCT?
Intraoral Scanning
An optical scan turns the surfaces of the teeth and the visible soft tissue into a digital model. It uses no ionising radiation. It records the shape of tooth surfaces; it does not show the inside of the bone or the nerve canal. Which impression method is used depends on the conditions in the mouth and on the prosthesis planned.
Cone Beam Computed Tomography (CBCT)
CBCT is a radiographic method that helps assess the jawbone and the related anatomy in three dimensions, and it does involve ionising radiation. A CBCT is not needed at every visit or for every digital impression. Whether it is needed is decided by weighing the examination and any existing images.
The field of view and the exposure settings are chosen for the clinical question. Dose varies with the machine and the protocol, so a single low-dose comparison cannot be made for all CBCT scans. Tell your clinician about previous imaging and about pregnancy.
What Gets Combined in an Implant Plan
Bone volume, neighbouring structures such as the nerve canal and the sinus, tooth surfaces, and the planned prosthesis are assessed together. Different records can be aligned in the same digital environment. Each record gives different information; a surface scan does not substitute for assessment of the bone.
The number, position and size of dental implants are not chosen by looking at a gap on a screen. Mouth opening, the gums, the bite, general health and the ability to clean all matter. Where bone is insufficient, additional procedures or different prosthetic options are discussed.
The Limits of Digital Planning
Image quality, patient movement, alignment of the records, manufacture of the guide and how it seats can all affect delivery. There can be a difference between the planned and the achieved implant position.
Tahmaseb and colleagues (2018) measured that difference across 20 studies and 2,238 implants: a mean error of 1.2 mm at the entry point, 1.4 mm at the apex and 3.5° of angular deviation, with the recommendation that a safety margin of at least 2 mm be respected. Schneider and colleagues (2009) reported mean deviations of 1.07 mm and 1.63 mm, and also early surgical complications in 9.1% of cases.
For that reason no promise is made of accuracy to a given fraction of a millimetre, or of eliminating the risk of nerve injury. Using a guide does not automatically mean flapless surgery, faster healing or fixed teeth on the day.
Which Treatments Does It Help With?
Planning is used where it changes a decision, not as a fixed add-on:
- Single and multiple implant placement, particularly near the nerve canal or where bone volume is limited
- All-on-Four and other full-arch plans, where implant distribution has to be considered with the prosthesis
- Zygomatic implant assessment, where the anatomy involved is more complex
- Sinus lifting, for assessing sinus anatomy and choosing the surgical approach
- Impacted tooth surgery, where the relationship to the nerve canal changes the approach
How Time and Cost Are Determined
Taking the records, preparing the plan and, where needed, manufacturing a guide are separate stages. The total time depends on whether existing records can be used, on the scope of treatment and on any manufacturing required. Which of the imaging, impression, guide and prosthesis items are included in the fee is set out in the treatment plan.
How to Prepare for Your Appointment
Bring any previous scans, your treatment records and a list of your medication. You do not need to have a new CBCT taken before getting in touch; whether one is needed is decided at the examination. A WhatsApp conversation is for making an appointment and for initial information — a diagnosis and treatment plan require an examination.
Frequently Asked Questions
Is digital planning compulsory?
No. It is used where it adds something to the decision — near nerve canals, where bone volume is limited, and where several implants are planned. Whether it applies to your case is discussed at the examination.
How long does planning take?
It depends on whether your existing records can be used, on the complexity of the case and on whether a guide has to be manufactured. The stages are set out in your treatment plan rather than quoted as a standard turnaround.
Does it add cost?
It can. Which records and planning steps are foreseen, what is included and what would be charged separately are agreed in writing with Dr. Gürel before treatment begins.
Scientific References
- Tahmaseb A, Wu V, Wismeijer D, Coucke W, Evans C. The accuracy of static computer-aided implant surgery: A systematic review and meta-analysis. *Clinical Oral Implants Research*. 2018;29(Suppl 16):416-435. PMID 30328191. DOI
- Schneider D, Marquardt P, Zwahlen M, Jung RE. A systematic review on the accuracy and the clinical outcome of computer-guided template-based implant dentistry. *Clinical Oral Implants Research*. 2009;20(Suppl 4):73-86. PMID 19663953. DOI
- Block MS, Emery RW. Static or dynamic navigation for implant placement — choosing the method of guidance. *Journal of Oral and Maxillofacial Surgery*. 2016;74(2):269-277. DOI
- ADA: X-rays and patient selection criteria
Treatment Steps
Examination and Review of Existing Records
Your complaint, your expectations and your previous treatment are assessed, and the necessary records are selected. Not every investigation is repeated simply because a digital plan is being made. Natural teeth that could be kept are also assessed at this stage.
Designing the Surgery and the Prosthesis Together
The planned tooth positions are considered alongside the bone support. Temporary and definitive prosthetic options, the need for additional surgery and the alternatives are discussed. The design on the screen is a planning tool, not a promise of how things will look after healing.
Choosing How It Will Be Delivered
In suitable cases a surgical guide can be prepared for guided implant surgery. Not every digital plan is delivered with a guide. The guide's support, how it seats in the mouth and surgical access are assessed beforehand.
Checking During the Procedure, and Follow-Up
The actual tissue conditions are assessed against the plan. If necessary the implant position, an additional procedure or the timing of the prosthesis are reconsidered. Having digital records does not remove the need for healing checks and long-term maintenance.
Examination and Review of Existing Records
Your complaint, your expectations and your previous treatment are assessed, and the necessary records are selected. Not every investigation is repeated simply because a digital plan is being made. Natural teeth that could be kept are also assessed at this stage.
Designing the Surgery and the Prosthesis Together
The planned tooth positions are considered alongside the bone support. Temporary and definitive prosthetic options, the need for additional surgery and the alternatives are discussed. The design on the screen is a planning tool, not a promise of how things will look after healing.
Choosing How It Will Be Delivered
In suitable cases a surgical guide can be prepared for guided implant surgery. Not every digital plan is delivered with a guide. The guide's support, how it seats in the mouth and surgical access are assessed beforehand.
Checking During the Procedure, and Follow-Up
The actual tissue conditions are assessed against the plan. If necessary the implant position, an additional procedure or the timing of the prosthesis are reconsidered. Having digital records does not remove the need for healing checks and long-term maintenance.